Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process


Prior Authorization in Medicare Advantage
    CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance the administrative process in Medicare Advantage (MA), Medicaid, and Affordable Care Act exchange plans.

The lawmakers are specifically requesting that CMS:

  • Implement real-time electronic prior authorization decisions for routine services.
  • Mandate that plans respond to prior authorization requests within 24 hours for urgent care.
  • Demand detailed transparency metrics.

    Read more: https://www.allzonems.com/prior-authorization-in-medicare-advantage/

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